Step 4: Attach your Audiologist/Dispenser Recommendation and Medical Information Form
These forms can be found in the application you downloaded. They must be filled out by a doctor and scanned in order to be submitted online. If you cannot scan your documents please mail your application along with the supporting documents.
Step 5: Attach a copy of your Georgia Medicaid Card
If you do not receive Medicaid, please skip to Step 6.
Step 6: Please attach proof of Georgia Residency
You can prove Georgia residency using one of the following:
1. A Lease Contract (if renting)
2. A Mortgage Statement (if you own your home)
3. Referral from a shelter or transitional home, or
4. Referral from a nursing home.
Step 7: Please provide proof of Income
Household income must include all persons residing at the applicant's address. Please provide the following information for everyone living at the applicant's address:
Last year's tax return and any of the following that apply
1. Three current pay check stubs
2. Social Security Administration Award Letter
3. Food Stamp Papers from Family & Children Services (award summary notification)
4. Unemployemnt claim, if unemployed - wage inquiry statement from GA Department of Labor
5. Information indicating the applicant is receiving TANF, Social Security Disability, Pension, Retirement, Veterans dministration Benefits, or any other sources of income
6. Last three months of bank statements and/or
7. Letter from nursing home stating income benefits.
Please scan all documents into one file and attach it below.
Step 8: Please provide the results of your hearing test
Please contact the Lighthouse for a list of providers in your area. The hearing test may not be older than six months. The Lighthosue does not pay for hearing tests. Medicaid and Medicare may or may not cover an annual hearing exam.